Over 43% of the newly diagnosed breast cancers in the U.S. occur in women 65 years of age or older (Yancik, et al., 1989), and the majority of these are diagnosed at a later stage (Goodwin, et al., 1986). Population based screening programs which include regular mammograms can reduce breast cancer mortality among women over 50 by 40% (Shapiro, et al., 1985), yet mammography utilization decreases with age. The primary objective of this research is to promote mammography utilization among women aged 65 and older, through the development and evaluation of interventions tailored to the unique concerns and age-related needs of these women. They have been selected on the basis of potential effectiveness, replicability, and cost- effectiveness. They include: modification of an existing telephone counseling intervention to meet the needs of women over 65; an updated free Mammogram Referral sent automatically; and a personal letter sent following the telephone counseling, summarizing the major points covered in the counseling. use of three comparison groups, Group 1 (receiving only the revised telephone counseling), Group 2 (receiving an automatic referral in addition to the counseling), and Group 3 (receiving an automatic referral and a personalized letter) provides for assessment of the impact of the different combinations of interventions. Data collection points include a baseline survey conducted at the time of the initial telephone contact, a 4-month follow-up telephone survey, and validation of mammography utilization through the US HEALTHCHECK database, which includes 7,500 women between 65 and 74 who belong to an IPA-model HMO. The major dependent variable is mammography utilization; other variables of interest include changes in knowledge and beliefs, sociodemographic characteristics, and baseline beliefs and knowledge. Utilization will be confirmed through radiologist's reports. The analyses will permit an assessment of the most effective combination of interventions in promoting mammography utilization and in changing knowledge and beliefs related to breast cancer and mammography.